Gait Training Flashcards
Components of Gait Training
- PRE-GAIT INITIATION
- AMBULATION OVER LEVEL SURFACES
- AMBULATION ON UNEVEN SURFACES
- CORNER NEGOTIATION
- CURB/STAIR NEGOTIATION
- RAMPS/HILLS
- FLOOR TRANSFERS
Level ambulation progression
- parallel bars
- walker/bilateral crutches
- unilateral device
- no device
What should you promote during level ambulation
- normal gait mechanics
- heel to toe pattern
- equal step length and stance times
- pelvic and trunk rotation (gotta get normal pelvic rotation back to decrease risk of lumbar/back pain)
Energy expenditure with prosthetic gait
- energy expenditure leg amputees use more energy to walk the same distance that non-amputees do
- amputees have higher levels of oxygen consumption
*** they may need more breaks
Why are crutches better than walker?
can take normal step length
which direction does TTA patient typically fall
posterior and to amputation side
which direction do patients with mechanical knee typically fall?
likely will buckle and fall forward
- you should stand on side of prothesis and anterior
3 things you need for successful gait
- pelvic rotation
- heel to toe gait
- full weight shift
Breaking gait into sequences
- staggered stance with weight shifting
- step onto prosthetic limb with sound limb swing
- step onto sound limb with prosthetic limb swing
- transverse pelvic rotation
Transfemoral Pre-Gait Training
- LEARN HOW TO CONTROL KNEE
(LOCKING/UNLOCKING) - SWING – UNLOCK KNEE BY ENGAGING HIP FLEXORS
AND PUTTING WEIGHT ON PROSTHETIC TOE - STANCE - LOCK KNEE BY ENGAGING HIP EXTENSORS
WITH WEIGHT ON HEEL - DON’T NEED TO DO WITH MICROPROCESSOR KNEES
corner negotiation
- take bigger step with outside foot and pivot on inside foot
- outside foot can be either prosthetic or sound
- initially more pts prefer to pivot on sound limb
- use wide turns to avoid loss of balance and knee strain on pivoting foot
- practice both directions
General progression for stairs
- bilateral railings
- one railing and device
- one railing
- device only
- no rails
Ascending stairs
lead with sound side
descending stairs
lead with prosthetic side
TFA stairs prognosis
- probs gonna have a step to gait for ascending, can possibly do reciprocal going down
- microprocessor knee can eventually do reciprocal
Stair negotiation - TTA
able to ascend and descend reciprocally due to intact knee joint
stair decent with hydraulic knee
- have sufficient friction at ranges greater than 20 deg knee flex to facilitate reciprocal pattern
- descend by placing prosthetic foot halfway off step
non hydraulic knee stair negotiation
- no friction at greater than 20 deg knee flex - controlled fall
- requires significant amount of balance and motor control as well as confidence
- can use step ups with prosthesis to promote WB and hip ext strength
why are ramps/slopes challenging for prothetic users
- stiffness of ankle: less adaptable to incline/decline
- TF: lack of knee and eccentric quads control
two strategies to navigate ramps/curbs
- shorten step length of involved limb (step to pattern)
- turn partially sideways and use a side stepping pattern or zig-zag pattern
floor transfer
- perform early on in treatment
- perform with and without prosthesis
- push up on furniture
- push up on assistive device
how to do floor transfer
- pivot on sound limb
- get in quadruped
- sound limp propped up
- push through sound limb and find something to pull yourself up
special considerations - microprocessor knees
- 70% of body weight indicates stance phase resulting in increased friction
- Need to WB 70% BW on forefoot for 0.1 sec to unlock knee
- can facilitate knee flex up to 20 deg at initial contact
to change from stance phase to swing phase with microprocessor knee:
- must weight shift onto prosthesis for stance and off for swing
Special Considerations - Stubbies
- used for initial training with Bilateral TFA
- shorter pylons
- lowers center of gravity
- makes initial balance and use easier
- some patients like to use in home
Special Considerations - running with a prosthesis
- intact leg acts like a spring to absorb impact forces, store energy, and return at push-off for propulsion
- elasticity of achilles tendon reduces workload of gastroc/soleus complex
- impact forces can be as high as 2x body weight depending on running pattern
what do TTA runners rely on?
hip/ knee extensors
more considerations for TTA runners
- shorter swing time = shorter step length = lower GRF
- stiffness on prosthetic components does not change in step frequency
- have to adapt running pattern to inherent stiffness of running prothesis
more considerations for TFA runners
- delay in prosthetic swing resulting in hop-skip method
- reduce hip flex at end-swing in preparation fro stable heel strike –> shorter step length
- greater loading impact force translated to residual limb
- energy-storing foot reproduces 0.97 GRF absorbed
- pattern will be dictated by prosthetic knee component
